Jornal Vascular Brasileiro最新文献

Background: Blood pressure measurements in the hallux and fingers are important in evaluation of patients with diabetes, obese patients, dialysis patients, and those with peripheral artery disease.

Objectives: In this article, we tested a prototype of an automatic device for measuring systolic pressure in fingers and toes, combining optical plethysmography and a pressure sensor, with a cuff encircling the finger or toe, and controlled by a microcontroller.

Methods: The prototypes (a total of 3 identical devices) were tested for initial validation (with a group of participants who already had symptoms of peripheral arterial disease [PAD], n=30) and also in clinical comparisons between controls (n=15) and participants with diabetes (n=15). The following variables were tested: Ankle-brachial index; Toe-finger index; Toe-brachial index, and toe pressure in isolation. For validation, the toe pressure in isolation was measured with two devices (the prototype under test and the SysToe® device), to analyze the correlation between the two measurements.

Results: The correlation between the two devices was strong (R=0.88) in the group with symptoms of PAD. Toe-brachial index was lower in patients with diabetes than in control participants (p=0.005) as was the Toe-finger index (p=0.03), however, the Ankle-brachial index was similar in these two groups (p=0.92).

Conclusions: The findings show the feasibility of the device for measuring finger and toe pressures, and possibly indicate greater sensitivity for detecting early-stage arterial disease using this type of measurement.

The systematic review with meta-analysis aimed to investigate the occurrence of Chronic Venous Insufficiency (CVI) in patients with Type II Diabetes Mellitus (T2DM). The guiding research question was structured using the PECOT framework (P: population; E: exposure; C: comparison; O: outcome; T: type of study), and the risk of bias was assessed using the ROBIS-I tool. A total of four studies were included in the analysis. The findings revealed that the prevalence of CVI in patients with T2DM was 55%, with a prevalence ratio of 1.51 (95% CI: 1.01 to 2.26). These results suggest that individuals with T2DM have a significantly higher prevalence of CVI compared to those without the condition. However, the review identified several limitations, such as the scarcity of longitudinal studies and variability in the diagnostic criteria for CVI among the included studies. The authors conclude that further research is warranted to address these gaps and deepen understanding of the relationship between T2DM and CVI.

Atrial septal defect (ASD) is a common cardiac defect with significant implications if left untreated. Although open heart surgery is the traditional approach, transcatheter closure devices, such as the Amplatzer™ Septal Occluder Device, have gained prominence due to advantages like shorter hospital stays and reduced costs. Among potential complications, device migration is a rare complication, with an incidence of 0.5 to 1.1%. We report a rare case of migration of an Amplatzer™ device in an asymptomatic patient, diagnosed 6 months after its implantation. After detecting the issue, the medical team opted for percutaneous device removal followed by open surgery to correct the ASD. In conclusion, managing Amplatzer™ device embolization requires careful consideration of the patient's circumstances and device anatomy. This case highlights the importance of correlating clinical and imaging findings when selecting the management approach and assessing the feasibility of a less invasive approach in cases of late migration.

Type III endoleaks are characterized by a problem with the endograft structure, such as fracture of the metallic structure, separation, or rupture. They constitute a rare complication, occurring in 2.1% of patients after treatment of abdominal aortic aneurysm by endovascular repair, with higher incidence in first and second generation endografts, and can occur early (after 30 days) or later. This type III classification is subdivided into IIIa -modular separation of components - and IIIb - mesh fracture or rupture involving the endograft. This case report describes an asymptomatic patient who had previously undergone infrarenal abdominal aortic aneurysm repair and underwent follow-up computed tomography which found a type IIIa endoleak with separation of the main body from the proximal extension. A second endovascular intervention was performed to seal the endoleak and correct the aneurysm.

Background: While radiofrequency ablation (RFA) is increasingly used to treat saphenous vein incompetence, its adoption in Brazil may have been hindered by the lack of evidence demonstrating sufficient added value to justify its cost-effectiveness.

Objectives: To perform RFA in 9 patients with lower extremity varicose veins and determine the procedural costs per patient at a Brazilian teaching hospital.

Methods: Nine single-use RFA catheters were purchased by the teaching hospital affiliated with our institution and used in this pilot study. Direct and indirect costs were calculated as sums of the respective cost components of the procedure based on values from the federal government's price panel. To illustrate the potential cost-effectiveness of RFA, these costs were compared to those of 9 saphenectomy procedures performed on the same day as the RFA procedures. All analyses were descriptive, with no formal statistical testing.

Results: The mean operating room hourly rate for RFA was 127.50 BRL. The costs of anesthetics/medications, materials, and single-use catheter per patient were 32.63 BRL, 81.49 BRL, and 1600.00 BRL, respectively. Patients were absent from work for < 15 days (mean, 11.44 days), not incurring sick leave payments from the Social Security Administration. The total mean cost for RFA was lower than that of same-day saphenectomy (1841.62 BRL vs 2045.40 BRL).

Conclusions: This pilot study provided essential insights into resource utilization at a Brazilian teaching hospital, with the goal of improving treatment efficiency and ensuring the best cost-benefit ratio for patients.

Background: Varicose disease is a common pathology among the population, with an incidence of about 38%. In Brazil, it affects 45% of women and 30% of men. Currently, endovenous thermal ablation (EVTA) of the saphenous vein is the method of choice in the treatment of varicose veins. As a minimally invasive procedure that promotes quick recovery and does not require hospitalization, it can be performed on an outpatient basis.

Objectives: To evaluate the safety and cost-benefit of outpatient varicose vein treatment in a clinic compared to the same procedure performed in a hospital environment.

Methods: A uncontrolled retrospective transversal study of case series evaluated a random group of 50 patients undergoing EVTA for the treatment of varicose disease by the same group of vascular surgeons. Twenty-five underwent the procedure in a tertiary hospital environment and 25 on an outpatient basis. The average costs of room fees and materials from both groups were analyzed and statistically compared with the Student's t-test. Intraoperative and postoperative complications were assessed.

Results: The average hospital cost of the procedure was R$ 1391.99 (± 280.8) in the hospital and R$ 1593.40 (± 99.53) in the clinic. The Student's t-test showed a significant difference with p=0.02. No patient had complications either intraoperatively or postoperatively.

Conclusions: Outpatient surgery, despite having a statistically higher cost than hospital surgery in Brazil, is safe and has a positive cost-benefit for the patient.

Plantar vein thrombosis is a vascular disease that affects the medial and/or lateral plantar veins. Its clinical manifestations are generally non-specific. However, it usually presents with pain in the plantar region, edema, and difficulty walking. The disease predominantly affects middle-aged females and is idiopathic in the majority of cases. The most commonly associated risk factors are recent surgical procedures, cancer, use of oral contraceptives, local trauma, and genetic disorders, such as hereditary thrombophilia. The gold standard diagnostic test is vascular ultrasound, evaluating venous compressibility. We report a case of venous thrombosis of the lateral plantar vein diagnosed with vascular ultrasound.

Background: The treatment of thoracoabdominal aortic aneurysms (TAA) has advanced. Understanding the pathophysiology and surgical approaches to this disease is essential for best therapeutic performance.

Objectives: We aimed to improve previously described methods for creating thoracoabdominal aortic aneurysms in a porcine animal model, reducing surgical procedure time and specimen mortality.

Methods: A total of 18 swine underwent a surgical procedure to create a TAA. An autologous peritoneal patch was used to create the aneurysm in 2 animals, and a bovine pericardial patch was used in the other 16. The animals were followed up postoperatively, and the aneurysm sac was reexamined after 4 weeks. The animals that did not die in the post-operative period were euthanized according to institutional recommendations.

Results: All of the animals underwent laparotomy with retroperitoneal access. Two received an autologous peritoneal patch and 16 received a bovine pericardial patch. Three animals underwent single suprarenal clamping, while 15 underwent sequential clamping. There were no differences in operative time (p=0.207) or total clamping time (p=0.276) between groups. There was a higher mortality rate after 4 weeks in animals that received single clamping (100%) than sequential clamping (26.7%) (p=0.0017).

Conclusions: The experimental model of TAA using a bovine pericardial patch and a sequential clamping technique provided a stable and reliable platform that remains stable and patent for up to 4 weeks. This model can be extremely valuable for assessing new endovascular therapy options in living organisms.